ArticleThe American journal of medicine2015
Sensitive troponin assay and the classification of myocardial infarction.
Article in The American journal of medicine, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 65 papers, 4 of them syntheses that pooled it.
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Who cites it
65 citing papers in PubMed, 4 syntheses or guidelines pooled it.
- Long-term major adverse cardiovascular events following myocardial injury after non-cardiac surgery: meta-analysis.BJS open · 2023Pooled it
- Pooled it
- Variations on classification of main types of myocardial infarction: a systematic review and outcome meta-analysis.Clinical research in cardiology : official journal of the German Cardiac Society · 2019Pooled it
- Pooled it
- Restrictive Versus Liberal Transfusion in Patients With Type 1 or Type 2 Myocardial Infarction: A Prespecified Analysis of the MINT Trial.Circulation · 2024Trial
- Implementation of a high sensitivity cardiac troponin I assay and risk of myocardial infarction or death at five years: observational analysis of a stepped wedge, cluster randomised controlled trial.BMJ (Clinical research ed.) · 2023Trial
- Assessment of Oxygen Supply-Demand Imbalance and Outcomes Among Patients With Type 2 Myocardial Infarction: A Secondary Analysis of the High-STEACS Cluster Randomized Clinical Trial.JAMA network open · 2022Trial
- High-Sensitivity Cardiac Troponin and the Universal Definition of Myocardial Infarction.Circulation · 2020Trial
- Effects of alirocumab on types of myocardial infarction: insights from the ODYSSEY OUTCOMES trial.European heart journal · 2019Trial
- High-sensitivity troponin in the evaluation of patients with suspected acute coronary syndrome: a stepped-wedge, cluster-randomised controlled trial.Lancet (London, England) · 2018Trial
- Trial
- The Effect of Restrictive vs Liberal Blood Transfusion Strategy on Subsequent Myocardial Infarction Type.JACC. Advances · 2026Article
- Impact of in-hospital ACEI use on long-term prognosis in discharged type 2 myocardial infarction patients: a retrospective propensity score-matched cohort study.BMC cardiovascular disorders · 2026Observational
- Type 2 myocardial infarction: challenges in diagnosis and treatment.European heart journal · 2025Review
- Altered Arterial Stiffness, Ventricular-Arterial Coupling and Troponin Levels in Patients with Systemic Lupus Erythematosus.Medicina (Kaunas, Lithuania) · 2024Article
- Characterization of Myocardial Injury With High-Sensitivity Troponin.Texas Heart Institute journal · 2023Article
- Impact of clinical diagnosis of myocardial infarction in patients with elevated cardiac troponin.Heart (British Cardiac Society) · 2023Article
- Elevated Cardiac Troponin Is Most Often Associated With Type 2 Myocardial Infarction in Trauma Patients.Cureus · 2023Article
- Detection of grey zones in inter-rater agreement studies.BMC medical research methodology · 2023Article
- Takotsubo Syndrome: The Secret Crosstalk between Heart and Brain.Reviews in cardiovascular medicine · 2023Review
5 more citing papers are in PubMed but not listed here.
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Authors and funding
15 authors.
Funding
Abstract
backgroundLowering the diagnostic threshold for troponin is controversial because it may disproportionately increase the diagnosis of myocardial infarction in patients without acute coronary syndrome. We assessed the impact of lowering the diagnostic threshold of troponin on the incidence, management, and outcome of patients with type 2 myocardial infarction or myocardial injury.
methodsConsecutive patients with elevated plasma troponin I concentrations (≥50 ng/L; n = 2929) were classified with type 1 (50%) myocardial infarction, type 2 myocardial infarction or myocardial injury (48%), and type 3 to 5 myocardial infarction (2%) before and after lowering the diagnostic threshold from 200 to 50 ng/L with a sensitive assay. Event-free survival from death and recurrent myocardial infarction was recorded at 1 year.
resultsLowering the threshold increased the diagnosis of type 2 myocardial infarction or myocardial injury more than type 1 myocardial infarction (672 vs 257 additional patients, P < .001). Patients with myocardial injury or type 2 myocardial infarction were at higher risk of death compared with those with type 1 myocardial infarction (37% vs 16%; relative risk [RR], 2.31; 95% confidence interval [CI], 1.98-2.69) but had fewer recurrent myocardial infarctions (4% vs 12%; RR, 0.35; 95% CI, 0.26-0.49). In patients with troponin concentrations 50 to 199 ng/L, lowering the diagnostic threshold was associated with increased healthcare resource use (P < .05) that reduced recurrent myocardial infarction and death for patients with type 1 myocardial infarction (31% vs 20%; RR, 0.64; 95% CI, 0.41-0.99), but not type 2 myocardial infarction or myocardial injury (36% vs 33%; RR, 0.93; 95% CI, 0.75-1.15).
conclusionsAfter implementation of a sensitive troponin assay, the incidence of type 2 myocardial infarction or myocardial injury disproportionately increased and is now as frequent as type 1 myocardial infarction. Outcomes of patients with type 2 myocardial infarction or myocardial injury are poor and do not seem to be modifiable after reclassification despite substantial increases in healthcare resource use.
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